Substance Use
Overdose mortality among those engaged in opioid use disorder treatment in New York City Sean Locke* Sean Locke Gail Jette Nicole DAnna Hannah Johnson Jason Graham Chinazo O Cunningham
Overdose death risk is extremely high for those with opioid use disorder (OUD). Medication treatment is first-line OUD treatment, reducing the risk of overdose death by >50%. Other forms of OUD treatment vary in reducing overdose death. Few studies have examined the impact of different treatment modalities on overdose death. We assessed overdose death risk among those in OUD treatment using a retrospective cohort design.
We matched individuals receiving NYC-based OUD treatment data from the NYS Office of Addiction Services and Supports to overdose death records from the NYC Chief Medical Examiner (study period: 01/01/16-07/31/19). Target trial emulation was adopted to address preexposure covariates and align key time points. Cox proportional hazard model was used to estimate crude (cHRs) and adjusted hazard ratios (aHRs) with 95%CIs. Sex, age, race/ethnicity, housing, and employment were covariates in the adjusted model based on evidence from the literature and subject knowledge.
We identified 73,125 individuals receiving OUD treatment in NYC with 538 died of overdose during treatment. The annual overdose death rate was 39.6-48.5 per 10,000 individuals in the study period. Those reporting problematic alcohol use (cHR 2.2, 95%CI:1.8, 2.7) were more likely to experience overdose death compared to those without problematic alcohol use. In the adjusted model, those receiving medication-based treatment were significantly less likely to experience overdose death compared to other treatment modalities (aHR: 0.36 95%CI:0.3, 0.5).
We found that individuals engaged in medication-based OUD treatment had the lowest overdose death rate compared to other treatment modalities. Overdose prevention interventions and medication-based treatment may be particularly important for those with OUD and problematic alcohol use. Strategies to expand equitable access to medication-based OUD treatment are crucial to reducing overdose death risk among populations with OUD.